Why am I going to the bathroom so much during the middle of the night?

Jean Robey, MD, is an internist and nephrologoist on staff at Banner Estrella Medical Center. Her office can be reached at (623) 974-1763.

Question: I am a 67-year-old man with no history of heart or lung problems. I have noticed recently that I am getting up at night, sometimes three times a night, to go to the bathroom. What can I do about it?

Answer: Nocturia is a common problem defined as waking at night to void – a completely separate issue from urinary frequency throughout the day. These nighttime wakings can cause significant sleep disturbances and have even been linked to depression and decreased productivity. Most of the time, symptoms of nocturia are progressive and can vary from night to night. Rarely does it come on as a sudden, new condition.

Any disorder that results in one or more of the following can contribute to nocturia: 1) increased volume of nighttime urine output, 2) low bladder voids or 3) generalized sleep disturbances.

There are various causes of increased urine output during the night. Normal nighttime variation in the naturally occurring hormone vasopressin prevents nighttime voiding. This variation may be disrupted for various reasons. Additionally, solutes normally made by the body need to be excreted and the timing of this and varying amounts may affect urination. Furthermore, fluid shifts in patients with chronic swelling due to heart failure, venous insufficiency or heavy protein excretion can also lead to nighttime urination. Finally, damage to central nerves can result in inappropriate nighttime urination as in Parkinson’s disease or stroke.

Possible causes of low bladder voids include low bladder volumes or overactive bladder and bladder obstruction (e.g. related to benign prostate hypertrophy (BPH) or enlarged prostate). Decreased bladder volume and overactive bladder is common in seniors. BPH is common in men and may or may not be related to prostate cancer. Medications and/or surgery may help.

Finally, primary sleep disturbances (e.g. obstructive sleep apnea or restless leg syndrome) may create a misperception about the reason you are waking up. Sleep studies that monitor patients while they sleep can help detect sleep disorders and provide treatment recommendations.

A thorough history of symptoms, current medications, intake and output of fluids and comorbid medical problems can help your doctor determine the cause of your nighttime waking. From there, appropriate treatment options can be determined and you can get a good night’s rest.